Enteral Nutrition via Nasogastric Tube for Refeeding Patients With Anorexia Nervosa: A Systematic Review

Abstract

Weight restoration is an important first step in treating patients with anorexia nervosa (AN), because it is essential for medical stabilization and reversal of long-term complications. Tube feeding may help facilitate weight restoration, but its role in treatment remains unclear. This study aimed to review the literature describing the efficacy, safety, tolerance, and long-term effects of nasogastric (NG) refeeding for patients with AN. Four electronic databases were systematically searched through May 2018. Boolean search terms included "anorexia nervosa," "refeeding," and "nasogastric tube feeding." Ten studies were eligible for inclusion: 8 retrospective chart reviews, 1 prospective cohort, and 1 randomized controlled trial. Nine of the studies were performed in-hospital. In 8 studies, NG nutrition resulted in an average rate of weight gain exceeding 1 kg/wk. In 4 of 5 studies including an oral-only control group, mean weekly weight gain and caloric intake were significantly higher in tube-fed patients. Six studies provided prophylactic phosphate supplementation, all with <1% occurrence rate of refeeding hypophosphatemia. Seven studies reported on other physiological disturbances, 6 evaluated medical and gastrointestinal side effects, 3 considered psychological outcomes, and 4 assessed patients postdischarge. Results indicated that NG feeding was not associated with an increased risk for adverse outcomes. Overall, in these studies, NG nutrition was considered safe and well tolerated, and effectively increased caloric intake and rate of weight gain in patients with AN. However, results are limited by weaknesses in study designs, and more rigorous methods are needed for development of evidence-based, standardized refeeding protocols.

Development of consensus‐based guidelines for outpatient dietetic treatment of eating disorders: A Delphi study

“…It is not possible, however, to determine whether these results suggest components such as exposure to feared foods and monitoring of weight should not be included in dietetic treatment or that they should be led by a non‐dietetic clinician. Additionally, no consensus was reached regarding a standard approach to management of re‐feeding and rate of weight gain in outpatients with AN, consistent with previous research which has identified the same issue in regards to re‐feeding protocols for inpatients with AN (Rizzo, Douglas, & Lawrence, 2019).…”

Avoidant restrictive food intake disorder: First do no harm

“…Although most children are able to take nutrition by mouth, NGT feedings may be considered if the child is unable to meet their energy requirements with oral feeds. To this end, reviews to guide decision‐making in the use of NGT feedings in anorexia nervosa (AN) have been published and should be considered in guiding this decision in children with ARFID in the context of medical instability (Garber et al, ; Rizzo, Douglas, & Lawrence, ; Zuercher, Cumella, Woods, Eberly, & Carr, ). Notwithstanding, to date, evidence‐based guidelines for NGT feedings in ARFID are lacking and therefore current clinical practice is based on experience and consensus.…”

Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews

“…Our literature review found various narrative reviews concerning somatic aspects of AN, but only a few recent systematic reviews concerning multi-organic somatic medications. In fact, most systematic reviews are concerned with the effects of weight gain or pharmacological treatments (hormone replacement, biphosphonates, teriparatide, and vitamin K) on bone mineral density and secondary osteoporosis [39,44,49,50] or they concerned nutritional therapeutic modalities and their impact on weight changes [42,46], or the efficacy of nasogastric enteral nutrition and adverse effects [47,52,53]. Most of the studies involved small samples, with heterogeneity within and among studies concerning evaluations, biomarkers and age range, with heterogeneous adolescent and adult populations, and various durations, often with an insufficient follow-up.…”

“…One recent systematic review [53] including 10 studies, confirmed that EF is a safe therapeutic tool that is well tolerated for the management of AN patients, with an average weight gain > 1kg/week and enhanced calorie intake and weight gain in the four studies comparing EF to oral-only refeeding. Long-term effects associated with nasogastric enteral refeeding are only reported in the RCT study [108], with a higher mean body weight at 12 months in the EF group.…”